Treatment of delayed union of humeral shaft fractures by interlocking nailing

Fifteen patients [nine males and six females with a mean age of 43 years] with delayed union of humeral fractures were treated by interlocking nail. The time delay between injury and operation ranged from 3.5 and 4.5 months with a mean of 4 months. Three patients had proximal fracture, 8 had middle third and 4 had distal third fractures. Antegrade nailing was done in 4 patients, while retrograde nailing was fine in 11 patients. Only 4 cases needed open reduction and iliac cancellous bone grafting, 2 of them had also primary radial nerve palsy. The mean period of follow up was 9.66 months and the mean period of healing was 5.8 months. The results, evaluated according to the criteria of Rommens et al. [1999], were excellent in 12 patients, good in one patient, fair in one patient and poor in one patient. The primary radial nerve palsy improved after neurolysis during surgery and the nerve function recovered gradually during follow up

Anatomical variations of the palmar cutaneous branch of the median nerve

Twenty cadaveric upper limbs were studied to identify the course of the palmar cutaneous branch of the median nerve [PCBMN] and its relation to the commonly used surgical landmarks of the palm of the hand. Dissection was begun in the forearm by exposing the median nerve, then the incision was extended distally into the palm along the thenar crease. The PCBMN was then exposed at the radial side of the median nerve and traced distally into the palm. The relationship of the PCBMN to the overlying soft tissue landmarks was then measured at the level of the distal wrist crease. The palmar cutaneous nerve of the median nerve was found closely underlie the thenar skin crease [range of 6 mm ulnar to 6 mm radial to the thenar skin crease]. The nerve traveled an average of 5 mm radial to the interthenar depression [range, 0- 12 mm redial]. So, these anatomical variations should be recommended for surgical approaches to the carpal tunnel release

Operative treatment of pelvic fractures

The goal in the treatment of pelvic fractures is to achieve and maintain reduction. Open reduction and internal fixation of the anterior pelvic ring with AO reconstruction plate performed in was 5 cases while AO tubular external fixator was used in ano-DrCh Orth Assiut Max - Landolt DrCh Surg Zurich ther cases, internal fixation was used for cases associated with laparotomy or exploration of the bladder by the general surgeons. Posterior fixation was not used in any case. The use of preoperative traction and eark surgical treatment were essential to achieve exccellent results. The procedure was not associated with an increased rate of infection or neural injury. In the 10 patients followed for an average of 17.1 months, there was no late displacement and all the fractures were healed. AO evaluation program was used and the results were one excellent, 4 good, 4 fair and one poor. Pelvic fractures usually result from high energy trauma and are often associated with several other injuries. [1] During the acute phase of management, the orthopaedic surgeon will often combine efforts with other specialists, particularly the general surgeon and the urologist. [2] The anatomy of the pelvic ring has been described in detail by many authors, who emphasized the weight bearing posterior structrues. [3] Lesions of the anterior part of the ring are less critical to the stability of the pelvic ring that is intact posteriorly. It is therefore necessary to study both survival and the natural history of the various types of pelvic trauma. [4]. The use of external fixator has expanded since it-was initially employed in Europe for stabilization of fractures of the pelvic ring. It has been reported to provide sufficient stability to allow adequate osseous healing of rotationally unstable but vertically stable fractures of the pelvic ring, particularly if an adequate initial reduction has been achieved. [5, 6] Biomechanical studies have shown that the external fixator, regardless of the configuration applied cannot stabilize the posterior disruption in an unstable pelvic ring, so some other method must be added, such as traction or internal fixation. [5, 7, 8, 9]. Anterior fixation has been used for disruption of the symphysis pubis of more than 2 centimeters, for fractures of the pubic rami with marked displacement, or after a laparotomy. [5, 6, 9]. On this paper we evaluate the results of the operative treatment of pelvic ring fractures, either by the AO tubular external fixator or by internal fixation of the anterior pelvic ring using the AO reconstruction plate, comparing the results with that reported in literatures

Open reduction and ao osteosynthesis of acetabular fractures a preliminary report

A total of 20 cases of fracture of the acetabulum, 10 in Stadtspital Triemli, Zurich, Switzerland, and 10 in the Department of Orthopaedic Surgery and Traumatology, ElMinia University Hospital, ElMinia, Egypt. Sex: 17 males, 3 females. Age: Range 17 - 49 years, mean 35.5 years. Period: 1988 - 1992. Open reduction and AO osteosynthesis by compression screws alone or combined with AO reconstruction plate. Delay: 1 - 28 days, 65% of cases within 7 days. Follow up 12 - 24 months [average 14.7 months]. Excellent 4, Good 13, Fair 2, Poor 1; Radiological: Excellent 2, Good 15, Fair 2, Poor 1. Best results were obtained whenever it was possible to restore the congruity of the articular surface of the acetabulum